Justine Strand de Oliveira: Relationships are the most important aspect of leadership

After a career working in a variety of roles and settings, a leader in the physician assistant field says that understanding people is central to leadership development.

Editor's note: This interview is part of a series on leadership development.

Justine Strand de Oliveira says her career makes sense in retrospect.

Her professional experience includes working in Brazil, lobbying in Texas, treating OB-GYN patients and serving as director of general services in a county health department -- all of which helped make her the leader she is today.

As varied as those jobs are, Strand de Oliveira says she learned important lessons in each setting and draws on all of them in her current position as vice chair for education for the Department of Community and Family Medicine at the Duke University School of Medicine. She has served as the head of the Physician Assistant Program.

Justine Strand de OliveiraStrand de Oliveira trained at Duke as a physician assistant and later earned a master’s and a doctorate in public health from the University of North Carolina.

She didn’t plan to go into leadership. But, she says -- paraphrasing Woody Allen’s famous line that “80 percent of success is showing up” -- “I’ve just shown up, a lot.”

In her years promoting her profession and working in different environments, the most important leadership lesson, she says, has been the importance of building relationships.

“I think you build relationships because that’s what we should do as human beings and that’s what gives us joy in our day -- that’s what we’re meant to do. But it also helps you be successful,” she said.

Strand de Oliveira spoke to Faith & Leadership about learning and practicing leadership in the physician assistant field. The following is an edited transcript.

Q: In your career, you’ve done a lot of different things, including working in another country. How has that influenced your work as a leader, a supervisor and someone who guides leadership development of others?

I always say that the two most important experiences, in terms of my leadership management approach: one is the lobbying with no money, no power; the other is living in Brazil and being immersed in that culture, because it’s so driven by relationships.

And those are really the same things, you know.

In Brazil, one has to maintain relationships with family, with friends, with business associates.

I was an American [physician assistant]. We were odd enough in those years [in the U.S.], but in Brazil, no such thing existed. And I handled things with our expat Westinghouse community on the basis of a satellite phone, which was very high tech at the time, you know, ’82 to ’84.

But I had to rely on the local physicians. They had a very good hospital and very good physicians there, and one of the things I had to do was to make sure I went by to visit with them on a regular basis, because if I didn’t do that, it would be offensive for me to go and say, “I need help with this.”

And you never start a conversation by, “I need Mr. Jones’ X-ray.” It’s, “Hi, how are you doing? How’s the family?” You have to have the social interaction and interest in that person, because if you go straight to business, that’s just a typical American.

I think that depending on where you live in the United States, that’s important. It’s important in the South; we’re all about relationships, and I think that’s a beautiful thing.

I think you build relationships because that’s what we should do as human beings and that’s what gives us joy in our day -- that’s what we’re meant to do. But it also helps you be successful.

Q: How did you move into leadership in your profession?

I moved to Texas and discovered when I got there that it was really a terrible practice environment for PAs. I was president of the Texas Academy of PAs. There was a bill filed in the Texas Legislature, a very problematically written bill. And so I had to jump in as an amateur lobbyist and work to get that as straightened out as it could be. Two years later, I lobbied the first licensing law for PAs. I just got involved because things needed to get done.


Justine Strand de Oliveira is an avid reader of leadership literature. Here are some of her recommendations:

  • Blue Mind: The Surprising Science That Shows How Being Near, In, On, or Under Water Can Make You Happier, Healthier, More Connected, and Better at What You Do by Wallace J. Nichols
  • Conscious Business: How to Build Value through Values
    by Fred Kofman
  • Drive: The Surprising Truth About What Motivates Us by Daniel H. Pink
  • Give and Take: Why Helping Others Drives Our Success
    by Adam M. Grant
  • Why CEOs Fail: The 11 Behaviors That Can Derail Your Climb to the Top and How to Manage Them
    by David Dotlich
  • The Breakout Principle: How to Activate the Natural Trigger That Maximizes Creativity, Athletic Performance, Productivity, and Personal Well-Being by Herbert Benson and William Proctor

My lobbying experience was one of the most formative things that happened to me, that created the type of leader I am, because I had no money and no power. The only thing I had was persuasion.

So I had to reach people where they were, and there was a lot of opposition. The medical society was opposed; the osteopathic medical society was opposed to our licensing bill; the nurses association was opposed. And I worked at building relationships with all of them, turned around their opposition, learned from the problems they saw in the legislative language that we were proposing. The bill became better, and the bill passed -- every committee in both houses, without any opposition -- but it was a matter of persuasion.

Q: How did you move into managing and leading people?

[In Texas,] I took care of two young women through their pregnancies [and follow-up] who had had very big challenges in life, and their children were maybe a year or two old and they were just getting their lives together.

This was 1990, 1991, something like that, and both of these young women started having odd symptoms. And I diagnosed them both with being HIV-positive, and that was at a time that this was a death sentence; there was no treatment.

And it affected me so much that I felt like I had to get in the prevention side, so I had a desire to get into public health.

And at the same time, I had been very, very disappointed in management in health care, and I perhaps egotistically thought I could do a better job than a lot of the people I was observing.

So I actually took a very large cut in pay to move back here to Durham and take a job at the Durham County Health Department as director of general health services. I continued to practice, and I managed that clinic and multiple others and had a total staff of about 60 that reported up through me. And this is never having been a manager before.

Q: So it sounds as if your leadership development was kind of “sink or swim”; you jumped into things and then figured out how to do it. Do you recommend this as a way of learning?

There’s a very well known business writer, Ken Blanchard, who says the best predictor of success is a manager’s desire to be one. And I think one of the problems I’ve seen over the years is that our HR systems in most organizations are set up that in order to get promoted, in order to make more money, you have to start supervising people.

And I think a lot of people end up supervising people who don’t have -- that’s not their gift, that’s not their inclination, that’s not really what they want to do, but they end up doing it in order to get promoted.

And I think that if people who have a natural inclination, a natural curiosity and an openness, an ability to listen -- and I don’t mean to suggest that good managers of people have to be extroverts. I don’t think that’s true at all; I think we have an extroversion bias in this country, or culture. But I think the desire to do it and the willingness to admit your mistakes and learn from mistakes and learn from things that -- everyone can teach you, people who report to you, people who maybe you see as a barrier.

I think you just learn as you go and it has a beginning, but it has no end. I think the best approach is recognizing that you’ll continue to make mistakes, no matter how many years of experience you have.

Q: You’re in the business of training others, but you also are involved in leadership development of your own staff. How do you approach that?

There’s a really interesting book I read recently, “Drive,” by Daniel Pink, and it’s all about what motivates people. And it’s really not money; he said money’s only an issue to the extent that you get the issue of money off the table. So it has to be enough money, but once it’s fair, people are motivated by meaningful work, by being part of something.

My approach is to really try to be a good listener; I try not to forget my experiences reporting up. And I also think that management isn’t just managing down; it’s managing up and managing sideways.

So all those relationships are important, and I think we have to do well with all of them to be successful in achieving the goals of the organization.

Q: Have you set up any particular processes of leadership development?

If I were left to my own devices, I would do things very differently. I don’t believe in annual reviews. I think they will go the way of the dinosaur, but most people are not there yet. I really feel that if you have good people, things work well and you need to just support them and give them the tools to do what they need to do and give them the flexibility to have good lives and be able to spend time with their families and so forth.

The idea that we sit down once a year and do an evaluation has almost a pejorative feel to it, and it’s often relatively worthless, because everybody gets a gold star. If there’s an issue, we should be dealing with it on a timely basis.

But I think that people have trouble doing that, which is why we see a lot of management by exception, where you’ve got 100 people working on something and you’ve got one or two people that are doing something really problematic.

In management by exception, you stand up and you tell everybody, “We have a new rule: Nobody can do X, Y, Z.” And 98 people are insulted and offended, and the two people that were problematic don’t think it applies to them.

We often fail to deal with individuals because those are difficult conversations. I think we should be on an ongoing basis communicating, meeting regularly, talking about what’s going well, talking about how we could do things better. If there are actual problems that come up, we should sit down and talk about that.

I have been amazed over the years that what I think happened, when there’s a problem, is not what happened. And so I sort of have a canned phrase, which is, “Help me understand what happened with ...” rather than, “Why did you not do this?” or, “Why did you do that?”

Because half the time, there are ingredients in what went wrong, system problems that I had no idea about. And we learn something; we actually fix things a lot. And I think that rather than approaching it as evaluation, I like to approach it as professional development.

I think that the most important part of the annual review that we have at Duke is, “What new skills do you want -- what things do you want to jump in and do?”

I think we should always be helping people to grow and learn and get new skills, and we’re afraid to do that because we have good people and we don’t want them to leave.

But I would rather have an organization where I have wonderful people who grow and develop so well that maybe they outgrow my organization and move on. Then I have a reputation as a manager, as a leader, who creates a great workplace and that people really want to be part of, because they’re growing and developing.

Q: How do you balance the needs of the individual and the organization?

Well, again, I have a radical opinion, which I can’t really act on. W. Edwards Deming, the father of total quality management, said it’s a benefit to the organization to send an employee to learn to play the violin -- and he was talking about manufacturing.

So my radical viewpoint is anything that helps people develop and grow is good for the organization. Now, I don’t own my own business, so I can’t send people to learn to play the violin.

But in the real world that I’ve lived in as a manager, as a leader, I have to look at whether this fits with our mission and is it something that can be applied. But I try to balance that with the wishes of the employee, in terms of what their personal goals are. So I try to blend those things while coloring within the lines that I have to color within.

I think the most important thing is to really talk with people, get to know people and get to know what really excites them, what interests them.

And it may be that, for example, someone who’s an administrative person really has an artistic side. Maybe they would learn to do layout and become really good with that and help us with that. And it doesn’t really take them outside their wheelhouse but gives them something fulfilling.

I’ve had a lot of opportunities to go through leadership training, and you learn a lot that way, but I think you learn something every day if you’re paying attention, so I just try to pay attention.